Provider Demographics
NPI:1063427771
Name:SHREEVE, MICHAEL W (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:SHREEVE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LAZY EIGHT DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6775
Mailing Address - Country:US
Mailing Address - Phone:386-322-9971
Mailing Address - Fax:
Practice Address - Street 1:900 N SWALLOWTAIL DR
Practice Address - Street 2:SUITE 104D
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6102
Practice Address - Country:US
Practice Address - Phone:386-256-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381310000Medicaid
FLT86016Medicare UPIN
FL89798ZMedicare ID - Type Unspecified